The escape last week of two mentally ill patients in state custody — one during an outing at a Spokane fair and the other from Pierce County's Western State Hospital — will likely change the way the state supervises so-called "forensic patients."

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The escape last week of two mentally ill patients in state custody — one during an outing at a Spokane County fair, the other from Western State Hospital in Pierce County — likely will change the way the state supervises so-called “forensic patients.”

Officials for the Department of Social and Health Services (DSHS), which oversees the state’s three mental institutions, have ordered a systemwide review of its security and safety policies, according to DSHS Secretary Susan Dreyfus. The state’s Department of Corrections will assist in the review.

Dreyfus said the review will result in new policies for patient outings and notification procedures in the event of a breach of security. In addition, questions about when the public should be notified in the event of an escape will be addressed, said Jim Stevenson, spokesman for DSHS.

Others, including the sheriff of Spokane County, are calling for an end to outings for the criminally insane.

On Thursday, Phillip Arnold Paul, who had been committed after being found not guilty by reason of insanity in the slaying of an elderly woman, disappeared during a field trip to the Spokane County Interstate Fair with 30 other Eastern State Hospital patients and 11 staff members. The escape prompted an extensive manhunt that ended Sunday when Paul, 47, surrendered to authorities near Goldendale, Klickitat County, about 180 miles from the fair.

It was the second time that Paul had escaped from state custody.

On Sept. 14, three days before Paul escaped, a 33-year-old man who was being held in the high-security criminal forensics facility at Western State Hospital walked away from the Lakewood facility, state officials said.

The man was missing for two hours before being seen by hospital employees who had been out looking for him. He was apprehended without incident by Lakewood police.

“It was a serious breach, and we’re starting a comprehensive review of all security at Western in response,” said Richard Kellogg, director of the Mental Health System for DSHS.

Kellogg said the 33-year-old who escaped from Western had been court-ordered to the hospital to have his competency restored in relation to a criminal matter. Kellogg would not disclose any more information about the man nor the manner in which he escaped.

In addition to the review of security measures at the mental hospitals, Dreyfus ordered an indefinite halt to all outings involving forensic patients — someone committed as a result of criminal proceedings.

Paul’s release from incarceration so he could go on a field trip has drawn criticism from many, including Gov. Chris Gregoire and Spokane County Sheriff Ozzie Knezovich.

Diagnosed as a paranoid schizophrenic, he was committed for the 1987 strangling of Ruth Mottley, 78, in Sunnyside, Yakima County. Paul told authorities that voices in his head told him Mottley was a witch who was casting spells on him.

Because Paul was found not guilty by reason of insanity, he is not serving a criminal sentence, Dreyfus said. Under state law, patients can petition for conditional release if they can convince a judge they are mentally healthy.

Dreyfus said one result of this incident is that the state Legislature may be asked to change the law so that criminals who are judged to be insane would be sent to prison if they are deemed cured.

Eastern patients have taken outings into the community for years, and hospital officials say they can be a useful tool in treatment.

Patients must be cleared by a treatment team before they can go on trips to stores, parks and other sites, said Dr. Rob Henry, director of forensic services at Eastern State. They wear street clothing, and staff members are required to keep each patient within eyesight at all times.

Knezovich plans to ask the state Legislature to ban field trips for the criminally insane.

Paul previously escaped from the mental hospital in 1990. He was captured nearby, and he attacked and severely injured a deputy while being booked into the Spokane County Jail.

On Monday, Yakima Superior Court Judge Michael Schwab granted an order to return Paul to Eastern State Hospital.

According to the Spokane County Sheriff’s Office, Paul had disappeared from his group at around 11:15 a.m., but his absence was not reported until two hours later.

Spokane County sheriff’s Capt. Dave Reagan said in a news release that officers flooded the area upon hearing of the escape, but the lapse in time between his escape and police notification allowed Paul “at least a two-hour head start.”

The lapse in time between Paul’s disappearance and police involvement has been criticized and will be part of the review, according to DSHS.

“We see this as a warning, and we want to use it as an opportunity to re-evaluate our policies,” Kellogg said.

DSHS has promised a security review will be completed within 15 days.

Information from The Associated Press and Seattle Times archives is included in this report.